Download - Copyright © 2014 Wolters Kluwer All Rights Reserved Chapter 18 Patient Exams and Procedures
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Chapter 18
Patient Exams and Procedures
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Review Tip
• Can you identify instruments and equipment?• Practice recognizing various instruments and their medical uses• Also study the various body positions
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Procedures
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Procedures
• Every procedure has commonalities• Use 2 metrics to identify the patient• Utilize appropriate aseptic and safety practices• Explain the procedure to the patient• Assure patient is provided with and understands
all instructions• Medical assistant responsibilities
• Observe patient for baseline behaviors, changes, signs and symptoms
• Continue observation throughout entire visit• Promptly record all information• Compare previous data with newly obtained data
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PatientInterview
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Patient Interview
• Review the knowledge, techniques, and skills from previous chapters• Expected standards
• Professionalism• Adherence to HIPAA
• Interview process• Chief complaint• Symptoms• Medical-related histories
Family historyPatient medical historySocial and environmental historyScreen for abuse and domestic violencePreventive health maintenanceCondition-specific monitoring
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CommonAssessmentMeasuremen
ts
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Common Assessment Measurements
• Anthropometry• Comprises of signs, functions and capacities• Objectively determined by the senses• Objectively determined by specific equipment
and tests
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Vital Signs
Body temperature• Measured by thermometer• Use either degrees Fahrenheit or degrees Celsius• Thermometer
• Mercury• Electronic• Disposable
• Common sites
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Vital Signs cont’d
Pulse• “Beat” caused by expansion and relaxation of artery wall• Expressed in bpm• Regular rates
• Adults: 60 to 100 bpm with regular rhythm• Age 1 to 10 years: 70 to 120 bpm with regular
rhythm• Infants: 100 to 160 bpm with regular rhythm
• Methods to obtain pulse• Manual• Doppler • Electronic sphygmomanometer
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Vital Signs cont’d
Pulse cont’d• Anatomic sites
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Vital Signs
Respirations• Measurement of number of respiratory cycles per minute• Done by observation• Consists of inspiration and expiration
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Vital Signs cont’d
Blood Pressure• Measurement of force of blood on the artery walls during systole
and diastole• Record as fraction• Korotkoff sounds
• Phase I• Phase II• Phase III• Phase IV• Phase V
• Pulse pressure• Difference between systolic and diastolic
pressures
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Vital Signs cont’d
Blood pressure cont’d• Orthostatic pressure
• BP taken in 3 positions• Sphygmomanometer
• Mercury• Aneroid• Electronic
• Stethoscope
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Other Measurements
• Height• Recorded in feet and inches or centimeters
• Weight • Recorded in pounds or kilograms
• Comparisons of height and weight• BMI
Health risk assessment toolEstimate percentage of body fatNormal range = 18.5 to 24.9Underweight = <18.5Overweight = 25 to 29.9Obese = 30 and above
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Other Measurements cont’d
• Pediatric growth chart• Specific to
current age and sex of child
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Other Measurements cont’d
Vision• Acuity• Snellen chart• Ishihara color vision test• Tonometer• Ophthalmoscopy exam
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Other Measurements cont’d
Hearing• Otoscope exam• Hearing tests
• Startle• Whisper• Tuning fork
Weber testRinne test
• Audiometry• Impedance audiometry• Tympanometry
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Other Measurements cont’d
Common Respiratory Tests• Pulse oximetry• Pulmonary function test
• Spirometry• Peak flow meter
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PhysicalExamination Preparation
andAssistance
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PE Preparation and Assistance
• Type of examination determines how to prepare and what supplies are needed
• Always explain the procedure to the patient• Maintain privacy• Request patient undress as appropriate, providing gowns and drapes• Ensure patient comfort
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Common Supplies and Instruments
• Medical assistant responsible for ensuring all supplies and equipment are readily available
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Common Supplies and Instruments cont’d
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Patient Positions
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Patient Positions cont’d
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Patient Positions cont’d
• Jackknife• Patient lies on stomach• Exam table inverted with head lowered and
knees at 90-degree angle• Arms overhead• Sigmoidoscopic exams
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Examination Techniques
• Observation or inspection• Palpation • Percussion• Auscultation• Manipulation• Mensuration
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Common Medical Imaging
Exams and Select
Preparations
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Radiology
• Medical assistants require separate certification• May be required to provide patient education and preparation for
procedure• Various procedures and examinations
• X-ray (basic)• Angiography (angiogram)• Arthrography (arthrogram)• Barium enema (lower GI series)• Barium swallow (upper GI series)• Bone density scan• Cardiac catheterization• Cholangiography (cholangiogram)• Cholecystography (cholecystogram)
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Radiology cont’d
• Various procedures and examinations cont’d• CT• HIDA scan• IVP• KUB• Mammography• MRI• Myelography (myelogram)
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Radiology cont’d
• Various procedures and examinations cont’d• Nuclear medicine• PET• Radiation therapy• Retrograde pyelography• Ultrasonography (ultrasound)
Echocardiography (echocardiogram)Fetal ultrasound
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Assignment
• Read Chapter 18: Medical Assisting Exam Review for CMA, RMA, and CMAS Certification